Hyperbilirubinemia/Jaundice — Risk Factors — Clinical Pathway: All Settings

Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway

Risk Factors for Hyperbilirubinemia and Neurotoxicity

Risk Factors for Developing Significant Hyperbilirubinemia
  • Gestational age < 40 weeks
  • Jaundice 1st 24 hrs after birth
  • Discharge TSB or TcB close to the phototherapy threshold
  • Hemolysis from any cause, or rapid rate of increase of TSB or TcB:
    • > 0.3 mg/dL per hour in the 1st 24 hrs
    • or
    • > 0.2 mg/dL per hour thereafter
  • Phototherapy before discharge from the birth hospital
  • Parent, sibling requiring phototherapy or exchange transfusion
  • Family history and genetic ancestry suggest inherited RBC disorder including G6PD deficiency
  • Exclusive breastfeeding with suboptimal intake
  • Down syndrome
  • Macrosomic infant of diabetic mother
Hyperbilirubinemia Neurotoxicity Risk Factors
  • Isoimmune hemolytic disease
  • Other hemolytic diseases (e.g., G6PD deficiency)
  • Significant clinical instability in the previous 24 hours:
    • Sepsis
    • Acidosis
    • Asphyxia
    • Significant lethargy
    • Temp instability
  • Albumin < 3.0 g/dL

 

Reference

AAP, 2022 Clinical Practice Guidelines Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More weeks of Gestation